Billing, Coding, Auditing, Revenue Cycle Training by BCA

RevU

At BCA, we have the distinct pleasure of working with billers, coders, and clinicians from coast to coast. We’ve listened carefully to the struggles and needs of each organization and have responded by expanding our offerings. In order to efficiently answer the many questions we receive, we’re using this platform. Please browse the posts below for answers to your common questions and updates to information that is essential to your revenue cycle. If you don’t see your question answered here, feel free to submit it for consideration.

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RevU Recent Posts

  • PHE Changes
    With the public health emergency (PHE) declared to have ended on May 11, 2023, now is the time to update any current policies or practices that may have been implemented in your organization due to Covid-19. One of the most notable updates allows remote communication flexibilities to remain in place for an additional 90 days, […]
  • BCA Summary of Diagnosis Coding Updates for April 2023
    The International Classification of Diseases, Tenth Revision, ClinicalModifications (ICD10CM) is updated April 1st and October 1 st every year. Theseupdates provide opportunities to review the current HIPAA mandated diagnosiscoding guidelines, encourage team members to update the accuracy ofpatient’s chronic problem list and determine necessary educationalopportunities for the entire team This April 2023 update includes 42 […]
  • Bonnie Hoag Scholarship
    In honor of our founder, Bonnie Hoag, BCA dedicates an annual scholarship award for one worthy recipient to our Comprehensive Coding Education Program (CCEP). The recipient of the Bonnie Hoag Scholarship will receive a full tuition scholarship to our CCEP program that prepares attendees to sit for either their CPC or CCS-P credential. Bonnie’s passion […]
  • 2023 E/M Guideline Changes Webinar
    January ushers in significant guideline revisions bringing welcome relief to the current coding drudgery. Clinicians will no longer have to worry whether a patient qualifies for inpatient vs. observation status when selecting their service code. We will see the removal of “bean-counting” requirements for history and exam elements, with guidelines aligning with the outpatient service changes we saw […]
  • 2023 Comprehensive Coding Education Program
    This comprehensive, on-demand course is designed to prepare students to become a nationally certified professional coder. This course is designed specifically to help coders thrive in a Federally Qualified Health Center environment. This course covers ICD-10-CM and Current Procedural Terminology (CPT) material and includes in-depth lessons on medical terminology and anatomy. CCEP also emphasizes appropriate […]
  • How Accurate is Your Diagnosis Reporting?
    Time to Focus on the Importance of ICD10CM Quality. As you are preparing for your 2023 production data to be analyzed, don’t forget about the importance of accurate ICD10CM reporting. It’s been common knowledge for years that ICD10 codes represent medical necessity for services provided to patients, however, quality reporting has only recently started to […]
  • BCA’s 99211 Factsheet
    With a current reimbursement rate of $23.53, it is evident that reporting 99211 can bring additional revenue into your practice. Reporting just five 99211 encounters per week could result in over $6,100 per year. The following guidelines can help assure you maintain compliance and receive the revenue you deserve for the services you may already […]
  • UDS Quality Measures and HRSA compliance
    Did you know that one of the compliance pieces of an FQHC is their quality program? Some clinics may refer to this as their CQI or QIQA committee/team. Part of this compliance program is based on accurate data in patient records, which coders can often assist with collecting. This data is then required to be […]
  • BCA Monday Morning Minutes
    Have a minute? Check out BCA Monday Minutes! Most recent Monday Morning Minute – Episode 18: Combination Codes
  • UDS Reporting Update
    As UDS reporting deadlines have surfaced, it’s important to know the HRSA Health Center Program FAQs about UDS reporting have recently been updated. Fun Fact: Beginning with the 2023 UDS reporting cycle, HSRA will also accept patient-level report data using Fast Healthcare Interoperability Resources. The following HRSA FAQ page https://bphc.hrsa.gov/datareporting/reporting/faqs is a great resource to visit common […]
  • BCA Coding Services
    Simplify Your Coding Practices while Maximizing Revenue At BCA, we always want to stay ahead of our client’s needs. With the ever-changing landscape of the healthcare industry and ongoing demands for FQHCs, we’ve found that there’s an immense need to support our Community Health Center partners with claims coding support. This is due in part to […]
  • AMA’s CPT 2022 Updates
    The American Medical Association (AMA) has released the 2022 Current Procedural Terminology (CPT®) code set, which incorporates a series of 24 vaccine-specific codes that are the model for efficiently reporting and tracking immunizations and administrative services against the coronavirus (SARS-CoV-2). The COVID-19 vaccine and administration codes are among 405 editorial changes in the 2022 CPT code set, […]
  • BCA No Surprises Act (NSA) Starter Toolkit
    With the No Surprises Act (NSA) set to take place for physician services come January 1, 2022, the BCA Team has put together a “No Surprises Act (NSA) Starter Toolkit” designed to help physician offices kick start implementation of this new rule. See the attached documents to get your team started today! Contact Us at […]
  • No Surprises Act Roundtable Event
    In November 2021, the No Surprises Act, was signed into law. This new law is designed to protect consumers from surprise medical bills related to “surprise” and “balance” billing, but what does this mean for our physician practices? We had a great discussion at our roundtable event on 12/1 and continue to learn more about […]
  • November is American Diabetes Month!
    According to the American Diabetes Association, one in three people in the United States have prediabetes. Check out their website to be aware how diabetes may affect you as well as some helpful tools to reduce your risk. Check out this simple diabetes diagnosis coding scenario that may occur in the office setting: Follow up […]
  • October is Breast Cancer Awareness Month: What better time than now to buff up your cancer documentation and reporting?!
    According to the World Health Organization (WHO), breast cancer is the most common cancer globally (as of 2021) and the second most fatal cancer in women. We encourage those that fall within the screening guidelines to get your mammogram scheduled today.   In order to assure appropriate coding for these conditions, it is critical to recognize causes, stages and […]
  • Managing UDS Measurements
    Peter Drucker famously said, “What gets measured gets managed.” We have spent some time recently exploring UDS Quality Measures, but where do we even begin to look at this data? How can we improve on data if we don’t know where to start? We are going to dive into an amazing place in this post, the world of HRSA data!  […]
  • Improving Population Health, One Patient at a Time
    We spend quite a bit of time looking at quality measures. Aside from our UDS reporting, why do we care about quality measures? The days of E&M reimbursement are soon going to be in the rearview mirror and value-based care is where our future lies. Because several of these measures are based on the eCQMs (Electronic Clinical Quality Measures), which are standardized by NCQA, UDS reporting also becomes very important to payers. Currently, many organizations live in […]
  • Telehealth Policy Updates as of 08/23/2021
    The Center for Connected Health Policy (CCHP) released current Telehealth Policy updates that break down the most common areas of focus right now. These updates include licensing laws, prescribing requirements, reimbursement policies and the best resources to track each. Although we have summarized some of these important updates from CCHP for your reference below, be sure to visit CCHP’s website for […]
  • Proposed Updates for 2022 Uniform Data Systems (UDS) Reporting: What You Need to Know Now
    Health Resources and Services Administration (HRSA) has recently released proposed updates to quality of care measures for 2022. This update is set to align clinical quality measures (CQMs) with the versions of the Centers for Medicare and Medicaid Services (CMS) electronic-specified clinical quality measures (eCQMs) designated for the 2022 reporting period.   Data-driven quality improvement efforts and full optimization of electronic health record (EHR) systems are strategic […]
  • Visit for Paperwork: Are these services medically necessary?
    The following scenario comes across our schedules/lists from time to time and is often reported with an Evaluation and Management (E/M) code (99202-99215) based on time.   Example: 44 year old male here for completion of paperwork, scanned copy into chart. ROS: None recorded. Exam: None recorded. A/P: Completion of paperwork and total face-to-face patient time 15 minutes.   When a patient presents without complaints, the visit likely does not […]
  • Coder’s Influence on UDS Quality Outcomes
    In FQHCs nationwide, UDS reporting is often thought of once a year and is generally a bad word muttered by CFOs and IT staff. However, it doesn’t have to be so difficult or segregated to such a small reporting team. Many teams are relying heavily on the reporting generated by their EMR system, which may […]
  • Emphasis on Health Equity in 2021
    Health equity means ensuring that everyone has the chance to be as healthy as possible. However, factors outside of a person’s control, such as discrimination and lack of resources, can prevent them from achieving their best health. Working toward health equity is a way to correct or challenge these factors. As defined by Executive Order by […]
  • Proposed ICD-10-CM Changes
    The ICD-10-CM Coordination and Maintenance Committee met on March 9th and 10th to discuss proposed changes for 10/1/2021.  Use this link to access the “Proposal Packet” for details about the requests, https://www.cdc.gov/nchs/icd/icd10cm_maintenance.htm April 9th is the deadline for public comments.  The committee will meet again in September.  Here are a few highlights of the requested […]
  • Best Practice Documentation for Nurses
    Q: Can you provide some information on best practice documentation for nurses when completing orders that are not performed on the date they were ordered?  A: This is a great question and the nurses in your clinic may also be a resource to answer your question.  While documentation may occasionally be viewed as being burdensome, […]
  • Undiagnosed New Problem
    Q: In the new 2021 E/M Guidelines what constitutes as an undiagnosed new problem? A: CPT defines an undiagnosed new problem with uncertain prognosis as “A problem in the differential diagnosis that represents a condition likely to result in a high risk of morbidity without treatment.  An example may be a lump in the breast.” […]
  • Lost Connection During Audio-Visual Telehealth Visit
    Q: If a telehealth encounter begins with audio-visual but they must convert to audio-only for the rest of the visit, how do you determine which code to use when the payer accepts the phone code 99441-99442 and the video code is 99212-99215? A: During the current Public Health Emergency, a variety of telehealth policies have […]
  • Two Clinicians Complete One Encounter
    Q: I have a patient encounter where 2 different providers working in our urgent care clinic completed orders for the same patient encounter.  I rarely see this type of documentation and I believe it happened because of shift-change during the encounter.  The first provider completed the majority of the visit, ordered a prescription and signed […]
  • Established Patient Follows Provider to New Clinic
    Note: For a new Medicare FQHC patient, see – Medicare FQHC Patients Follow Provider to New FQHC. Q: I have a new provider and several of her patients have followed her to our clinic.  Should these patients be coded as new or established at their initial visit in our clinic?  A: This question was answered […]
  • Medicare FQHC Patients Follow Provider to New FQHC
    Note: This question is specific to the Medicare FQHC new patient definition. For non-Medicare FQHC patients, see – Established Patient Follows Provider to New Clinic. Q: We have recently had providers join our team from other clinics and their patients have followed them. Can you tell me where I can find the guidelines for whether […]
  • Coding per MDM When Time is Documented
    Q: A provider completed an E/M in 25 min. The documentation supports Moderate MDM, does the service need to be down coded to a 99213 due to the documented time? A: Under the new E/M guidelines, code assignment is per Time or MDM for codes 99202-99215.  Time does not need to be documented when coding […]
  • E/M Coding in Mental Health
    Q: My question pertains to the new E/M guidelines in the setting of mental health.  Under Amount and/or Complexity of Data for codes 99205 and 99215, it states that 2 of the 3 categories must be met to count Data as Extensive.  For services provided in mental health we find we are only meeting 1 […]
  • Principal Care Management, G2064, G2065, in the FQHC.
    Q: My physician mentioned there is a new care management code that FQHCs can report for patients with one chronic condition.  Is that correct?  If so, what is the new code? A: Your physician is most likely referring to codes G2064 and G2065, Principal Care Management (PCM).  The codes were new in 2020 but were […]
  • Personal interpretation of radiology test during an E/M
    Q: Are there documentation suggestions for a provider’s personal interpretation of an x-ray under the new E/M guidelines when awaiting the radiologist’s formal read?  A: This a great question and a topic that requires unambiguous documentation. Otherwise, it may read as though the information was taken from the radiology report or as though the global […]
  • Documentation of ordered test
    Q: In order to be able to count a test (ex: lab, x-ray), must the order be documented in the office note or just anywhere in the chart for that day to count? A: Based on review of available payer information including Medicare, the treating/ordering physician or qualified healthcare professional (QHP) must clearly document, in the […]
  • MDM and Problems Addressed
    Q: Under MDM noting that a problem is being managed by another provider does not count as the problem being managed during the visit. But what if I, the patient’s physician, note that I reviewed that provider’s recommendations with the patient to ensure they were compliant, understood the instructions and other possible treatment options? A: […]
  • FQHC Funding Considerations
    The past year has presented many challenging situations for all businesses, and FQHCs have been hit especially hard with the COVID-19 pandemic. Throughout this time, they’ve seen shortages in PPE, staffing, and a demand for care like none other in their history. Fortunately, much funding has been made available to FQHCs to assist with their […]
  • Prolonged time codes 99417 and G2212
    Q: I’m confused with time-based coding and counting prolonged time and differences between 99417and G2212.  Please help! A: Both codes are designed to be reported only when using time-based coding according to the new E/M guidelines and only with codes 99205 and 99215.  The conundrum is related to application differences between the AMA and CMS. […]
  • Counting a test for MDM
    Q: My provider ordered a diagnostic test today, however, it will not be reviewed with the patient until the follow-up visit next week.  Is it correct that I can count the order today for a Data point in the MDM and when it’s reviewed next week, count another Data point for the review? A: Ordering […]
  • Counting unique tests under the new guidelines
    Q: Please help clarify the Data section of MDM under the new CPT/AMA guidelines and counting unique tests.  For example, the provider ordered a chest x-ray, an MRI and a CT, how is this counted?  And what if the provider ordered three different lab tests? A: Great questions!  Let’s first review the instructions in the […]
  • Telehealth without the patient present
    Q: If a provider performs a telehealth visit (audio/visual) for a pediatric patient, but only the mom was present during the service, may we bill the E/M? A: Telehealth has certainly changed the landscape in the past year.  Think of telehealth as a delivery mechanism.  If the clinician were to see mom for an appointment […]
  • Does a problem count as a problem addressed if it is for refill only
    Q: If the provider sees a patient for a specific illness and refills a medication for a chronic condition that was not addressed, does the moderate risk for medication management still apply or is it strictly related to the condition addressed during the visit? A: In short, no. You should not count prescription drug management […]
  • What constitutes a well-documented record? A coder’s perspective
    Q: The new AMA guidelines for 2021 state that the nature and extent of the history and/or physical examination is determined by the clinician reporting the service. With the history and exam requirements being removed from code selection, what standards should we encourage when reviewing medical records? A: A well-documented record has always been important, […]
  • Diagnosis coding for coexisting diabetes, hypertension, and chronic kidney disease
    Q: My clinician is asking which condition should be coded as causal to chronic kidney disease – hypertension or diabetes – when both are present. Specifically, clinicians are asking, “Why do we need to add the cause of CKD? We cannot be sure whether the cause was HTN versus Diabetes versus heart failure. We don’t […]
  • History of Present Illness in 2021
    Q: Should we continue to require HPI information for each problem in 2021? A: Answer: While we are certainly thankful for the 2021 guideline changes, we should not be so quick to put HPI and exam on the shelf. Codes 99202-99215 are defined as requiring medically necessary history and exam. While the extent may be […]
  • Prevention and illness management in the Same encounter for 2021
    Q: If a provider sees a patient for a wellness service or preventive exam (e.g., annual well woman exam) and also addresses concerns or chronic conditions, we’ve previously held the problem-oriented E/M to a lower level due to the comprehensive nature of the wellness service and difficulty carving out sufficient history and exam to support […]